Assessing malnutrition in older people

During emergencies the elderly are often identified as a vulnerable group who appear susceptible to malnutrition and disease. At the moment there are no standards for assessing the nutritional status of the elderly. In adults, body size and nutritional status are calculated using Body Mass Index (BMI is weight divided by height squared). The problem with doing the same for the elderly is that it can be difficult to measure their height because of spinal curvature or osteoporosis. Emergency selective feeding programmes are therefore often forced to include the elderly on an ad hoc basis using clinical observation as a basis for deciding who is admitted.

Help Age International in conjunction with the Centre for Human Nutrition at LSHTM have been carrying out research which aims to find a quick but reliable method of assessing malnutrition in older people in the developing world. The research is trying to find out which body measurements can be used as indicators of malnutrition, short-term mortality and functional ability in older people. The researchers also want to establish the relationship between anthropometry and functional ability (the ability to perform basic activities of daily life without support).

There are two sites where the study is taking place; one is in urban slums in Bombay (1390 slum dwellers) and the other in a refugee camp for Rwandan refugees in Karagwe, Tanzania (800 refugees over 50 years of age). Measurements are being taken of weight, arm circumference, calf circumference, armspan (the
distance between the middle fingertips of each hand with arms fully outstretched) and knee height (distance from foot to knee). Armspan and knee-height are thought to be good alternative measurements for height as they measure long bones which are not affected by ageing in the way that the spine may be. Physical tests to determine functional ability include handgrip strength, manual dexterity, psycho-motor skills, flexibility and lower muscle strength.

Initial findings from the Bombay site indicate that BMI (using armspan instead of height), MUAC and calf circumference most strongly predict functional ability impairment. These measurements are also relatively easy to take in the field. Further analysis is in progress to find out the most appropriate cut-offs for screening purposes. Results from Tanzania are expected later in the year.